Incisional hernias are the most common long-term complication of the midline laparotomy incisions, mostly repaired by ventral repair. This study aimed to compare the frequency of wound infection and seroma formation in patients undergoing onlay versus sublay mesh repair for ventral hernia. Methods:An Analytical cross-sectional study was conducted in the Surgical Unit of the University of Lahore Teaching Hospital from May 3, 2025 to November 3, 2025.A total of 140 patients were included and randomized into two groups: Group A (onlay mesh repair, n = 70) and Group B (sublay mesh repair, n = 70). Baseline demographics including age, gender, BMI, and socioeconomic status were recorded. All patients underwent standardized surgical procedures and were followed for 30 days postoperatively to assess wound infection and seroma formation. Data were analyzed using SPSS version 25.0. The Chi square test was applied, and a P-value of ≤ 0.05 was considered statistically significant. Results: Seroma formation occurred in 20.0% of patients in Group A compared with 5.7% in Group B. Wound infection was observed in 14.3% of patients in Group A and 2.9% in Group B. Both complications were significantly higher in the onlay repair group. Conclusion: Sublay mesh repair was associated with a lower incidence of wound infection and seroma formation when compared with onlay mesh repair. It may be considered a safer and more effective technique for ventral hernia repair.

Postoperative pain management in hemorrhoidectomy remains a clinical challenge, with pudendal nerve block (PNB) emerging as an effective technique. Adding steroids to local anaesthetics may enhance analgesic efficacy and prolong pain relief. Objective: To compare the effectiveness of pudendal nerve block (PNB) using bupivacaine alone versus bupivacaine with dexamethasone in reducing perianal pain following hemorrhoidectomy. Methods: A prospective study was conducted at the Department of General Surgery, University of Lahore Teaching Hospital, Lahore, from July 31, 2024, to January 30, 2025. A total of 60 patients undergoing hemorrhoidectomy were randomly assigned into two groups: Group A (n=30) received PNB with 20 mL bupivacaine. Group B (n=30) received PNB with 20 mL bupivacaine and 8 mg dexamethasone. The blocks were performed bilaterally under spinal anaesthesia using anatomical landmarks. All patients received standard postoperative analgesia. Pain scores were recorded at 12 and 24 hours postoperatively using the Visual Analog Scale (VAS). Group comparisons were conducted using the t-test, with statistical significance at p ≤ 0.05. Results: The mean pain score at 12 hours postoperatively was significantly lower in Group B (1.90 ± 0.481) compared to Group A (2.47 ± 0.681), with a p-value of 0.001, indicating a statistically significant difference in pain relief. The addition of dexamethasone resulted in enhanced and prolonged analgesia without increasing adverse effects. Conclusion: The use of PNB with bupivacaine plus dexamethasone significantly reduces postoperative perianal pain after hemorrhoidectomy compared to bupivacaine alone. This combination provides superior analgesic efficacy and can be considered a safe and effective technique for pain management in perianal surgeries.

INTRODUCTION:Anastomotic leakage is a serious complication after colorectal surgery. Indocyanine green fluorescence angiography (ICG-FA) allows real-time perfusion assessment and may reduce leak rates; however, recent larger randomized clinical trials reported conflicting results. This meta-analysis aimed to clarify the effectiveness of ICG-FA in reducing anastomotic leakage and related complications following minimally invasive colorectal surgery. METHODS:We conducted a comprehensive search across the databases to identify relevant studies. The search results were imported into Covidence for article eligibility screening, and all relevant outcomes data were synthesized using risk ratios (RRs) or mean differences with 95% confidence intervals (CIs) in meta-analysis models using RevMan 5.4. CRD420251031138. RESULTS:Six randomized clinical trials involving 3264 participants were included. ICG-FA significantly reduced the risk of overall anastomotic leakage (RR: 0.66, 95% CI [0.53-0.83], P = 0.0005) and complications (RR: 0.88, 95% CI [0.78-0.99], P = 0.03). Subgroup analysis showed a significant reduction in leakage for left-sided anastomoses (RR: 0.57, 95% CI [0.44-0.75], P < 0.0001) but not for right-sided ones (RR: 0.90, 95% CI [0.53-1.51], P = 0.68). No significant differences were found in Clavien-Dindo ≥3 complications, reoperation rates, or hospital stay. However, the ICG-FA group had a longer operation time (mean difference: 5.57, 95% CI [1.56-9.58], P = 0.006). CONCLUSIONS:ICG-FA significantly reduces anastomotic leakage and overall complications in minimally invasive colorectal surgery, especially for left-sided anastomoses. However, its use is associated with a slightly longer operative time. Further research is needed to confirm its role in right-sided procedures and long-term outcomes.

Diabetic foot ulcers (DFUs) represent a significant complication of diabetes mellitus, often leading to prolonged hospitalisation, amputations, and increased morbidity. Effective wound healing strategies are crucial in reducing the burden of diabetic foot ulcers (DFUs), particularly in resource-constrained settings such as Pakistan.AFG Objective: To compare the effectiveness of vacuum-assisted closure (VAC) dressing and topical antibacterial dressing in promoting granulation tissue formation and reducing healing time in patients with diabetic foot ulcers. Methods: A randomised controlled trial was conducted at the Department of General Surgery, University of Lahore Teaching Hospital, from July 2024 to December 2024. A total of 60 patients with clinically diagnosed diabetic foot ulcers were randomly assigned into two groups: Group A received a VAC dressing, while Group B received a topical antibacterial dressing (fusidic acid followed by saline gauze). Outcomes measured included the formation of granulation tissue within two weeks and the duration of complete wound healing. Data were analysed using SPSS version 25. A p-value of less than 0.05 was considered statistically significant. Results: The mean age of participants was 56.2 ± 9.4 years. Granulation tissue formation within two weeks was significantly higher in the VAC group (86.7%) compared to the topical dressing group (60%) (p = 0.018). The mean healing duration was shorter in the VAC group (12.3 ± 3.4 days) than in the topical group (17.6 ± 4.2 days) (p<0.001). Stratified analysis showed significantly better outcomes in patients with higher BMI, poor glycemic control, and non-smokers in the VAC group. Conclusion: VAC dressing significantly enhances granulation tissue formation and reduces healing time in patients with diabetic foot ulcers compared to topical antibacterial dressing. Its implementation in tertiary care hospitals in Pakistan could improve wound healing outcomes and reduce the burden of diabetic complications.

BackgroundConventional axillary lymph node dissection (ALND) is associated with significant post-operative morbidity in patients undergoing breast surgery due to increased lymphatic leakage. LigaSure, an electrothermal bipolar vessel sealing system, provides better closure of the leakage. This study aims to compare the efficacy and safety of LigaSure against conventional techniques in patients with breast cancer underwent ALND and breast surgery.MethodsWe conducted a comprehensive search across the databases to identify relevant studies. The search results were imported into Covidence for article eligibility screening, and all relevant outcomes data were synthesized using odd ratios (ORs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs) in meta-analysis models using RevMan 5.4.ResultsTwelve studies with the total of 895 patients (LigaSure = 441; Conventional technique = 454) with breast cancer underwent breast surgery with ALND were included. LigaSure was associated with significantly lower post-operative drain volume (SMD: -0.39, 95% CI [-0.53, -0.24], P < 0.00001), shortened duration of drain (SMD: -0.51, 95% CI [-0.67, -0.34], P < 0.00001), and reduced hospital stay length (SMD: -0.57, 95% CI [-0.96, -0.18], P = 0.004) compared to conventional techniques. However, no difference observed in total operation time, intra-operative blood loss, seroma related outcomes and post-operative complications between the two groups.ConclusionLigaSure significantly reduced the lymphorrhea, duration of drain and hospital stay, however, it did not prove be effective in seroma-related outcomes.

Linkage studies have indicated a potential genetic predisposition to cholelithiasis. This study aims to determine the frequency of positive family history of gallstone disease in patients presenting with gallstones in a Pakistani population. A descriptive, cross-sectional study was conducted at the surgical department of the University of Lahore Teaching Hospital from June 30, 2023 to August 30, 2023. A total of 102 radiologically confirmed cholelithiasis patients were enrolled. Out of 102 participants, 75.5% (n = 77) were females, with a mean age at presentation of 42.1 ± 12.1 years. The study found that 32.4% (n = 33) of participants had a single family member with gallstones, 3.9% (n = 4) had 2 family members affected, and 1% (n = 1) had 3 family members affected. The attributable risk of genetics from our study was 37.2%. Additionally, there was no significant association between positive family history and earlier onset of disease. A significant percentage of Pakistani population may have gallstone disease due to genetic factors.

Objective: To identify the accuracy of surgical clinical acumen in diagnosing severity of appendicitis in adults. Study Design: Observational study (Prospective). Settings: This study was conducted at University of Lahore Teaching Hospital, Lahore (UOLTH); a tertiary Care Hospital, Lahore Pakistan. Duration: November 2021 to April 2022. Methods: After ERB approval (ERC 58/21/09), data collection proforma was administered to general surgeons at UOLTH, who were asked to anticipate the severity of appendicitis preoperatively depending on history, clinical examination, ultrasound findings and laboratory tests reports. Area under the curve (AUC) and the optimal cut-point values for clinical variables were identified by drawing Receiver operating characteristic (ROC) curves for identifying non- complicated appendicitis. Preoperative diagnoses were compared to operative findings using chi-square test. Data was analyzed using SPSS version 24 was used for data analysis and p-value of < 0.05 was accepted as statistically significant. Results: Surgeon’s prediction showed an accuracy of 85.9% with 89.3% positive predictive value and 78% negative predictive value and an error rate of 9.67%. Abdominal ultrasound demonstrated high sensitivity (95.8%) but lower specificity (29.1%) for appendicitis. Clinical variables, such as anorexia, nausea, and elevated temperature, exhibited a substantial diagnostic competence to distinguish complicated and non-complicated appendicitis. Conclusion: Surgeon’s prognostication in appendicitis is more accurate than clinical or imaging alone, yet errors persist. Caution in patient selection for conservative management is vital, aided by integrating clinical judgment with imaging.

Background: After surgery for breast cancer, there is a risk of increased wound drainage and seroma formation. Various treatments are utilized to overcome this issue with variable effectiveness. Objective: To compare the outcome of a single preoperative dose of intravenous steroid injection versus control group on wound drainage in patients undergoing modified radical mastectomy (MRM) for stage I and II breast cancer. Methodology: It is a randomized control trial conducted over a period of 6 months. Total 60 patients who underwent MRM for carcinoma of breast were included. They were divided into 2 groups with each group having 30 cases. In group-A 120 mg (3 ml) of injection depomedrol was given one hour before surgery while in group B, 3 ml of normal saline was used, and MRM was performed and two drains were placed. At the time of drain removal, drainage volume was assessed in both groups. Results: Mean age of the patients was 47.3±7.89 and the mean drainage volume in group A versus B was 672±117.63 and 1020±159.9 respectively. Among the patients, 51.7% had stage I and 48.3% had stage II breast cancer. The two groups had statistically significant difference in terms of mean drainage volume (p value =0.048). Conclusion: In patients who underwent MRM, prophylactic steroid injection was associated with significant reduction in mean drainage volume compared to normal saline. Keywords: Modified Radical Mastectomy, Steroid, Seroma Formation

Introduction: Hypocalcemia after thyroid surgery is most important and early complication1. The main aim of this study is to diagnose early hypocalcemia after thyroid surgery and its treatment options Method: 100 patients fulfilling inclusion criteria from December 2018 to February 2021 were included in this study who had undergone thyroid surgery (sub-total, near-total and total). Serum calcium less than 8.1 mg/dl, measured after 24 hours to 48 hours of surgery is taken as hypocalcemia. Following variables are assessed in this study, gender, age, pre-operative serum calcium levels and type of surgery. Hypocalcemia diagnosed by post-operative serum calcium levels, presence of numbness, Chvostek’s sign or Trousseau’s sign noted and analyzed by SPSS v20 was used for statistical analysis. p-value less than 0.05 was considered as statistically significant. Results: Early post-hypocalcemia developed in 71 (71%) patients of them 13(18%) were males and 58 (82%) were females and female gender is significantly more associated with hypocalcemia (p=0.001) Type of surgery (sub-total, near-total and total) is not related to development of early hypocalcemia (p=0.169). Patients who developed early hypocalcemia divided into two groups- A and B respectively. Group A is treated with oral calcium alone and B with oral calcium combined with Vitamin D3. The patients followed up for 6 months. The patients who treated with oral calcium and vitamin D3 combined responded well as compares with oral calcium alone (p=.001). Conclusion: This study suggests that female gender is associated with early hypocalcemia however there is no significant different type of surgery and patients who treated with oral calcium combined with vitamin D3 responded well as compared with oral calcium alone. Keywords: Early Hypocalcemia, thyroid surgery, Goiter

Background: Liver injury is the most commonly encountered trauma among all abdominal traumas. It is associated with high morbidity and mortality. The choice of treatment for such injury depends on the type as well as severity of injury. Objective: To determine the outcome in terms of (success and complications) of managing liver trauma either conservatively or with operative management. Methodology: 62 patients with liver trauma (blunt or penetrating) who presented in the surgical emergency department of Jinnah Hospital, Lahore were enrolled in the study. Detailed history, clinical examination and radiological examination of all patients were carried out using CT scan. Depending on the grade of injury and type of trauma patients were managed either conservatively or by operating them. Success of treatment and its outcomes were noted down. Results: The results revealed that the mean age of the patients was 40.1±11.74, mean diastolic blood pressure was 62.34±14.36, mean systolic blood pressure was 105.2±11.41, mean pulse rate was 92.37±19.06, mean respiratory rate was 19.8±5.353 and mean number of fresh frozen plasma (FFPs) infused were 2.8±0.81. Conservative management was carried out in 42 (67.7%) patients and operative management was carried out in 20 (32.3%). Out of these, conservative management was successful in 35 (56.5%) patients and operative management was successful in 18 (29%) patients. Common complications seen were intra-abdominal sepsis in 24.2%, bile leakage 14.5%, recurrent hemorrhage 6.5%, coagulopathy 3.2% and death 4.8%. Conclusion: Conservative management of liver trauma is highly successful and is associated with less complications and unless needed must be adapted and operative management should only be carried out in patients who have injury to liver of such an extent that cannot be managed conservatively. Keywords: Liver injury, Blunt trauma, Penetrating trauma, Conservative management, Outcome

Background: Health care burden has increased since the pandemic of Covid-19 has emerged. The healthcare resources are limited currently and majority surgeries have been postponed because of the current pandemic. Therefore, the main concern of carrying out any surgery at current point is mainly in those patients that are landing in emergency. Symptomatic inguinal hernia being a common presentation in emergency can be dealt by applying local anesthesia. Objective: To evaluate the outcome (in terms of efficacy and safety) of local anesthesia for managing symptomatic inguinal hernia in a tertiary care hospital during current Covid-19 pandemic. Methodology: It was a descriptive study.60 males were enrolled with inguinal hernia of age 30-60 years. IV line was secured and local anesthesia was administered under aseptic measures. Lichtenstein repair, a mesh technique was applied in all patients for treating the inguinal hernia. Patients were evaluated postoperatively after 2 hours and 6 hours for any complications. Results: Mean age of the patients was 38.2±10.542, Mean time to eat was 3.85 ±3.138. Mean time to ambulate was 4.37 ±2.51. Mean pain score was 5.78± 2.131 postoperatively and after 6 hours it was 2.24 ±0.84. Indirect hernia was present in 74% patients whereas direct hernia was present in 26%. 6.67% patients had nausea/vomiting, 3.3% developed hematoma and 1.67% had wound infection. Conclusion: Local anesthesia is effective in all patients who have to undergo inguinal hernia surgery, in terms of efficacy and safety. Keywords: Inguinal hernia, Local anesthesia, Covid-19 pandemic.

Background: Carcinoma breast is the commonest malignancy of females all over the world and second leading cause of death due to cancer among females. In Pakistan it is more common at a young age contrary to the West where it is more common in old age (after 60 years). The objectives of this cross sectional study were to determine the frequency of HER-2/neu receptor over-expression and its association with some of the features of breast cancer like patient age, ER/PR status, tumour size, histological grade and axillary lymph node involvement. Methods: This study was conducted at Surgery ward unit 2, Fatima Memorial Hospital, Lahore, from June 2015 December 2015. Study included all patients with breast cancer admitted in Surgery unit 2 of FMH, Lahore for Modified Radical Mastectomy (MRM). The resected specimens were sent to histopathologist for immunohistochemical (IHC) studies (HER-2/neu receptor and ER/PR) and detailed histopathological analysis including tumour subtype, size, histological grade and involvement of axillary lymph nodes. Patients refusing HER-2/neu receptor immunohistochemistry were excluded from the study. Name, age, sex, other relevant data, detailed history and clinical examination findings and results of investigation were recorded. Data was analyzed with SPSS version 10. Results: This study included 50 patients of breast cancer having modified radical mastectomy (MRM). Age distribution ranged from 45-61 years with a Mean±SD of age 52.2±4.3 years. 30 out of 50 patients (62.5%) were >52 years, while 20 patients out of 50 (40%) were ≤40 years of age. The HER-2/neu receptor status was found positive in 30 patients (60%) and negative in 20 patients (40%) of the total cases While, it was significantly associated with tumour size (p<0.05) and negative ER/PR status (p<0.05). Conclusion: Due to high prognostic significance and frequency in Pakistani females with breast cancer, HER-2/neu receptor should be checked in all patients with breast cancer so that the positive cases should have herceptin therapy and benefit from anthracycline based chemotherapeutic agents which can improve survival in these patients. Keywords: Breast carcinoma, HER-2/neu, ER/PR

Aim: To access the intention in final year medical students of MBBS and BDS to go abroad after graduation and impact of central induction policy and other factors on brain draining. Method: This cross sectional study was conducted on 150 final year students of University college of medicine and dentistry, Lahore (UOL) during July - August, 2016.The pretested self-administered questionnaire was designed after extensive literature review and was distributed. Data was analyzed using SPSS version 2.0 and p value <0.05 was considered statistically significant. Results: Out of 150 students, 84 were females (56%) and 66 were males (44%). Majority of students (91.3%) were in age group of (21-25 years).There were 91(60.7%) students who have planned to migrate abroad, 30(20%) have no plan to go abroad and 29(19.3%) were not sure about going abroad. Majority of students, 40.7% planned for UK, 34.7% planned for USA, 7.6% planned for Middle East countries, 6.8% planned for Australia and 10.2% mentioned other countries for migration. 83.4% were agreed that central induction policy(CIP) will increase brain draining,5.3% were disagree and 10.7% had no idea about CIP. Conclusion: Better carrier opportunity, Central induction policy, doctor harassment, peer pressure, to establish quickly and political instability were the reasons for the intentions in final year medical students to be established abroad. Lack of family support and resources, patriotisms, acism were reasons for rest of students(19.3%) to not go abroad.

Aim:: To estimate the prevalence and pattern of caffeine consumption among students of university of Lahore and to determine the knowledge about its benefits and side effects. Method: A questionnaire regarding the pattern, benefits and side effects of caffeine consumption were distributed to medical and nonmedical students of university of Lahore. Pilot study was conducted on 10 students before data collection. 185 university students (133 females, 52 males) were selected as a sample. Results: Among 167 students who know about caffeine, 123(66.5%) consume caffeinated products on daily basis. Most commonly consumed caffeinated products were tea (62.4%) soft drinks (52.8%) and coffee (41.6%). 77.4% students believed that caffeine enhances physical performance, 63.4% considered caffeine a harmful substance to health. Majority (41.6%) of the students had not experienced any withdrawal effects while others (24.8%) considered fatigue to be the most common one. Conclusion: Majority of the students showed knowledge about benefits of caffeine consumption, they also know some side effects but withdrawal effects and its therapeutic uses still needs to be addressed.

Aim: To study our experience TAPP repair of inguinal hernia in surgeons who have started this procedure from the very beginning independently and outcome regarding postoperative complications in TAPP repair of inguinal hernias especially comparing the use of absorbable tackers in one group and non-absorbable tackers in another group. Methods: We described our standard TAPP technique and evaluated the results of post-operative outcome regarding pain and complications. Results: We retrospectively reviewed our surgical unit experience of TAPP; we included in our study 63 patients. The sample was divided in to two groups: TAPP using absorbable tackers and TAPP using non-absorbable tackers. The group in which absorbable tackers were used are 44 in number and group with non-absorbable tackers were 19 in number. Mean follow up for patients was 12 months regarding post-operative complications. The recurrence rate was up to 5.2% in all patients. That high rate is the cause of early learning curve of the operating surgeon and improper mesh fixation. There was no major vascular but one case of small bowel injury which later died in due course of treatment of this complication. Mean operative time was average of 91 minutes. Postoperative pain in group in which non-absorbable tackers were used was not significantly higher than group with absorbable tackers. Recurrence was reported in 3 cases and all were within third week of surgery. Conclusion: In our experience TAPP procedure is safe and feasible procedure and there is a significant difference in postoperative pain when non-absorbable tackers are used, and post-operative complications in the early phase of learning curve do happen and its advisable to go through this phase under supervision of experienced surgeon over a period of at least one year.

Background: Pneumonia is defined as the inflammation of parenchyma of the lung. It is a substantial cause of morbidity and mortality in childhood throughout the world. The incidence of pneumonia in children under the age of five years is 0.29 episodes per child-year, which equates 151.8 million cases annually in developing countries. Objective: To determine the risk factors for complicated pneumonia. Material and Methods: This case-control study conducted in Medical Unit III, The Children’s Hospital & Institute of Child Health Lahore. Out of total of 180 cases of pneumonia, 100 were labeled as complicated pneumonia (case) and 80 were labeled as uncomplicated pneumonia (control). Complicated pneumonia included pneumonia with associated complications. Detail history was taken in both groups and recorded on predesigned proforma. Data was analyzed by SPSS 20. Quantitative risk factors like child age, maternal age and father age were analyzed by mean and standard deviation. However qualitative risk factors like method of feeding, malnutrition, immunization, anaemia, and non-vaccination were analyzed by applying chi-square test and finding odd ratios. Results: Most significant risk factors associated with complicated pneumonia included younger age, maternal and father education, rural area, malnutrition, anaemia, rickets, birth problems, admission during neonatal life due to pneumonia, bottle feeding, nonvaccination, referral and delayed in presentation (p <0.05). Conclusion: Important risk factors for complicated pneumonia like malnutrition, anemia, rickets, birth disaster, admission during neonatal life due to pneumonia, bottle feeding, nonvaccination, referred cases and delayed in presentation can be reduced by improving child health education and immunization. Please download the full paper by clicking on the PDF file below...

Background: Tobacco use is the single most important preventable health risk in the world and smoking-related mortality is set to rise in particular in developing countries including Pakistan. Smoking in surgical patients has been associated with local wound complications, pulmonary and cardiac complications, an increased need for postop intensive care and longer periods of hospitalisation. Aim: To ascertain the prevalence of smoking in Pakistani surgical outpatients and to assess their smoking behaviour with a view to increase awareness and suggest appropriate interventions. Study design: Cross-sectional survey Method: 300 consecutive general surgical outpatients were asked to identify if they smoked and were invited to take part in a semi-structured survey. The questionnaire had inbuilt questions from CAGE screening questionnaire modified for smoking and in addition asked questions about smoking behaviour and motivation to quit. Results: Prevalence of smoking in the study population was 45.6%. Out of these 45.2% screened positive for nicotine dependence. Majority of smokers acknowledged their habit. Boredom, anxiety or worry and feeling angry, depressed or lonely were identified as common themes of emotional state linked to smoking behaviour. Almost all the smokers identified health improvement and money saving as potential benefits of quitting. About two third (67.3%) of the nicotine dependent group and a half (50.7%) of the non-dependent group thought it was difficult to give up smoking. Nonetheless a significant majority in the both groups, 67.3% of the nicotine dependent and 80.9% of the non-dependent group considered that it was a good thing to quit smoking. Conclusion: Prevalence of smoking is high in Pakistani urban general surgical outpatients and is comparable to general population trends. A significant proportion of the smoking population may be dependent on nicotine. Smoking behaviour may be associated with a number of emotional states. Majority of the smokers are able to identify health and economic benefits of smoking cessation and have a positive attitude towards quitting despite thinking it may be difficult. Routine screening for smoking and nicotine dependence and appropriate support for smoking cessation and harm reduction should help promote a healthier lifestyle and improve outcomes in the pre and postoperative period.

Aim: To compare open pre-peritoneal mesh repair with Lichtenstein repair in complex inguinal hernias for early postoperative complications, postoperative hospital stay and recurrence. Method: The study was conducted in Surgical Unit-I, Nawaz Sharif Social Security Teaching Hospital, Lahore for one year from 01-01-2013 to 31-12-2013. Sixty patients fulfilling inclusion criteria were included in this study and they were divided into two equal groups A and B. The Group A was treated with open pre-peritoneal mesh and Group B was treated by Lichtenstein repair. Results: The mean age in Group A was 40.67 +/- 16.39 years and in Group B was 42.67 +/- 15.88 years. The mean postoperative hospital stay in Group A (open pre-peritoneal mesh) was 3.5 +/- 2.57 days. The mean Postoperative hospital stay in Group B (Lichtenstein repair) was 3.03 +/- 2.77 days. In Group A, 24 (80%) patients had mild pain and 6(20%) patients had moderate pain and in Group B, 25(83.3%) patients had mild pain, 4(13.3%) had moderate pain and 1(3.3%) patient had severe pain. In early postoperative complications in Group A, 2(6.7%) patients developed urinary retention, 1(3.3%) wound infection, 1(3.3%) wound haematoma, 3(10%) scrotal haematoma, 1(3.3%) scrotal seroma and there was no wound seroma. In Group B, 3(10%) patients developed urinary retention, 2(6.7%) wound infection, 2(6.7%) wound haematoma, 1(3.3%) scrotal haematoma, 1(3.3%) wound seroma and there was no scrotal seroma. Conclusion: Open pre-peritoneal mesh and Lichtenstein repair are comparable in postoperative hospital stay, early postoperative complications and recurrence rate.

OBJECTIVE: To determine the frequency of cerebrovascular accidents and brain abscess in children of Tetralogy of Fallot presented with neurological manifestations. PATIENTS AND METHODS: It was a cross-sectional descriptive observational study done at the Pediatric Cardiology and Pediatric Neurology departments of The Children’s Hospital & Institute of Child Health, Lahore from Dec 2009 to Nov 2010. A total 75 patients of Tetralogy of Fallot (TOF) up to the age of 15 years with neurological manifestation meeting the inclusion criteria were enrolled in this study. CT brain with contrast was conducted in all patients to look for evidence of cerebrovascular accident (stroke) and/or brain abscess. RESULTS: Out of total 75 patients of Tetralogy of Fallot (TOF) presented with neurological manifestation 48 (64%) were having brain abscess, 24 (32%) were having cerebrovascular accident (CVA), 2 (2.6%) were having intracranial bleed and 1 (1.3%) was having meningoencephlitis. Disease breakdown according to age showed increasing frequency of brain abscess as age increases with maximum cases above 10 years of age. However maximum cases of CVA reported in patients below age of 2years. CONCLUSION: Brain abscess have found to be more frequent than cerebrovascular accidents in patients with tetralogy of fallot. Therefore, we should have a high index of suspicion of brain abscess in every unoperated patient of tetralogy of fallot presenting with neurological manifestation.